Sheep Liver as a Model for Advanced Laparoscopic Hepatic Resection Training

Laparoscopic hepatic resection requires precise surgical skills. The sheep liver, closely resembling the human liver, emerges as a promising alternative for the advanced laparoscopic hepatic resection model. We aim to assess the suitability of the sheep liver as an animal training model for advanced laparoscopic hepatic surgery and identify potential limitations. This study, conducted at the 20th MESDA Conference in Bangkok on September 23-24, 2022, involved 10 sheep undergoing laparoscopic liver surgery training. Pre-training CT scans identified liver structures after general anesthesia administration. In groups of three, trainees performed live laparoscopic hepatic surgery on anesthetized sheep, with immediate feedback collected through post-training questionnaires assessing the clinical impact on live sheep models. 3D reconstructions revealed that 30% of sheep exhibited human-like ramification in the right portal vein (RPV), while 70% showed independent bifurcation patterns. The left portal vein (LPV) is consistently bifurcated into left medial and lateral sectoral branches, mimicking human anatomy. Hepatic vein drainage showed uniformity, with the right hepatic vein (RHV) forming a common trunk (MHV-like) before draining into the inferior vena cava (IVC). The participant's success rate was high, with 80.0% finding sheep model procedures realistic. Organ and tissue properties received high ratings, with 66.7% very high, 30.0% high, and 3.3% intermediate. Feasibility for advanced laparoscopic liver surgery on sheep models was very high (80.0%) and high (20.0%); overall, 76.7% rated laparoscopic liver surgery training very high in learning success. This study underscores the effectiveness of sheep liver as a suitable model for advanced laparoscopic hepatic resection training. Further research is needed to assess the model's effectiveness and limitations in specific laparoscopic hepatic techniques.